Hysteropexy. A review.
ABSTRACT Uterine prolapse is a common problem in women that negatively affects one's quality of life. Surgical treatment commonly involves a hysterectomy followed by vaginal vault suspension of some type. Hysteropexy to treat uterovaginal prolapse has a long history dating back to the 1800s and has gone through many changes. Recent literature describes vaginal, open abdominal and laparoscopic approaches. Vaginal sacrospinous hysteropexy is well-supported by the scientific literature. Favorable postoperative outcomes range from 62-100% and additional data show improved quality of life and sexual function. Anatomic outcomes appear to be comparable to vaginal hysterectomy with sacrospinous ligament vault suspension. Additionally, encouraging outcomes following pregnancy have been described. The sacrohysteropexy, performed through a laparotomy incision or laparoscopically, also has favorable data, with cure rates ranging from 91-100%. Studies supporting this procedure also describe improvements in quality of life and sexual function. Complications related to these procedures are similar to those described after vaginal vault suspension using comparable techniques, although most studies report shorter operative times and less blood loss. At the present time, hysteropexy, either transvaginal or abdominal, seems to be a safe procedure with acceptable results in women who desire uterine preservation. As these procedures gain popularity and data become available, questions related to patient selection, surgical durability, outcomes following pregnancy, and complications related to risk of uterine pathology will likely be answered.
- [Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to establish the number and trend of surgical procedures and pessary management of pelvic organ prolapse in England, using Hospital Episode Statistics (HES) data. An online search ( www.hesonline.nhs.uk ) was carried out. The number of various surgical procedures, as well as pessary insertions and removals for pelvic organ prolapse was obtained. Data were available for the 4-year period 2002-03 to 2005-06. Over 20,000 procedures performed and 600 pessaries inserted annually. The total number of patients having treatment for pelvic organ prolapse as well as the number of patients having surgery and pessary in English hospitals increased by < 10% over the previous year in 2 of the 4 years included and decreased by < 1% in one. Anterior vaginal wall repair was the commonest performed procedure for pelvic organ prolapse and sacrocolpopexy appears to be the most frequent procedure for post-hysterectomy vaginal vault prolapse. There was no change in trends between surgery and pessary over the studied 4-year interval (p < 0.05). The lack of specific codes precluded providing more detailed information. The availability of data sooner and for longer periods as well as the use of more specific codes are needed to provide more useful information.Journal of Obstetrics and Gynaecology 05/2014; · 0.60 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Pelvic organ prolapse and lower urinary tract fistulas are two disorders frequently managed in female urology. New techniques have been adapted and improved to decrease morbidity and improve clinical outcomes of these disorders. The adaptation of minimally-invasive approaches for the management of pelvic organ prolapse and lower urinary tract fistulas began with laparoscopy. However, laparoscopic surgery has not gained widespread popularity as a result of the associated technical challenges, such as intracorporeal suturing and pelvic dissection. Robotic surgery has been widely carried out in urological oncology since 2001, and has been widely adapted because of its advantages over conventional laparoscopy for the management of pelvic organ prolapse and lower urinary tract fistulas. The current literature has shown the safety, feasibility and favorable clinical outcomes of robotic surgery for the treatment of these disorders. Robotic surgery in the management of pelvic organ prolapse and lower urinary tract fistula repairs might offer a promising advancement and benefits. However, further long-term data should be followed to assess the durability of this newer, and minimally-invasive approach.International Journal of Urology 07/2013; · 1.80 Impact Factor